Hanno Steinke

Comparative anatomical measurements of osseous structures in the ovine and human knee

The ovine stifle has been increasingly used as a large animal model for the human knee. Still, comparative anatomical measurements of the knee in sheep and humans are missing. Thus, the purpose of this study was to describe and measure the osseous anatomy of the ovine stifle in comparison to the human knee. Twenty-four stifles of skeletal-mature merino-sheep and 24 human cadaver knees were obtained and distances between selected anatomical structures of the distal femur, the proximal tibia, and the patella were measured digitally and documented. Based on these, intercondylar ratio, tibial aspect ratio, patella aspect ratio and the cortical index were calculated. Regarding epicondylar width, lateral condylar width, medial condylar width and the tibial dimensions, the ovine stifle can be considered as a human knee scaled down by one third. However, sheep have a smaller trochlear width and a narrower femoral intercondylar notch than humans resulting in lower relative values for intercondylar width and intercondylar height. The distal femurs cortical index is the same in both species. In contrast, sheep have a massive bone stock below their tibial plateau and a proximal tibial shaft with remarkably thick cortical bone. The ovine stifle can be regarded as a useful model for the human knee. However, future studies should consider the differences in the femoral intercondylar notch width, the patellofemoral joints biomechanics and the proximal tibias cortical bone stock.

Deformation behavior of the iliotibial tract under different states of fixation

BACKGROUND AND OBJECTIVE The iliotibial tract (tract) is an important structure for the biomechanics of both the hip and knee joint. While a detailed characterization of its mechanical properties might help to better understand its specific role in the load transfer from the pelvis to femur and tibia, determination of those properties is complicated by its particular structure of thin fibers in the fresh state. Moreover, although the tracts mechanical properties are often derived from cadaveric material chemically fixed with either ethanol or formaldehyde, the influence of such fixation methods remains to be elucidated. Aim of this study was to determine Youngs modulus (tensile modulus, YM) of the tract. We hypothesized that either ethanol or formaldehyde fixation would significantly increase the YM compared to the tracts condition in a fresh state. MATERIAL AND METHODS 13 specimens of tract were gained from donators. The ends of the probes were plastinated with resin creating a sharp interface between the clamp and the probe to prevent material slippage. The specimens were measured in their fresh state, under ethanol- and formaldehyde-fixed conditions and re-measured after rinsing with tap water. RESULTS The YM of the fresh probes averaged 397.3N/mm(2) with a standard deviation (SD) of 151.5N/mm(2). The YM of the ethanol-fixed specimens was significantly higher (673.2N/mm(2), SD 328.5N/mm(2), p<0.05). After rinsing with tap water, the YM decreased to 95% of the fresh condition value (377.4N/mm(2), SD 144.5N/mm(2), non-significant change from fresh). After formaldehyde fixation, the YM reached 490.3N/mm(2) (SD 143.0N/mm(2), p<0.05). When the formaldehyde-fixed specimens were rinsed, the YM was 114% of the value of the fresh condition (452.6N/mm(2), SD 115.1N/mm(2), non-significant change from fresh). CONCLUSIONS This study found a significant influence of the chemical fixation method on the YM of the IT tract. If such fixation is required, our results suggest using a treatment with ethanol and subsequent rinsing that results in minimal changes to the tracts YM. Furthermore, plastination of the ends of the specimens could be crucial to allow in vitro determination of valid YM of ligaments data that can then be integrated with confidence in further finite element analyses.

A modified Spalteholz technique with preservation of the histology.

The Spalteholz technique for producing clear macroscopic specimens was introduced 100 years ago, and is still in use today because it immediately provides transparent three-dimensional specimens. The classical clearing procedure with peroxide severely damages formalin-fixed tissue and inhibits further investigation on a histological level. We, therefore, wanted to make a transparent specimen by a modified Spalteholz method and chose the human larynx as an example of a large specimen. Its blood vessels were injected with gelatin, the specimen treated with acetone and peracetic acid and subjected to freeze substitution. After complete dehydration, benzyl benzoate and dimethylphthalate were used for impregnation. The cleared specimen satisfactorily revealed the laryngeal blood vessels and such structures as muscles, cartilage and the thyroid gland. The histology of the laryngeal glands, thyroid tissue, and infrahyoid muscle fibres was preserved. Tissue shrinkage became apparent with subsequent steps of the clearing procedure. We conclude that our modifications maintain the transparency of the specimen and allow histological investigation. The herein described technique thus constitutes an improvement of the classical Spalteholz technique.

Ultimate stress and age-dependent deformation characteristics of the iliotibial tract.

BACKGROUND AND AIMS To understand biomechanics of ligaments and tendons data on their material properties are necessary. The iliotibial tract is a suitable model for virtual pelvic or lower extremity ligaments due to its parallel fibers, which facilitates biomechanical testing. Here, we determined Youngs modulus (YM) as secant stiffness between defined limits of the iliotibial tract and correlated the data to ultimate stress (US) of the specimens and to age, gender and body weight of the body donors. MATERIALS AND METHODS Thirty eight specimens from 12 iliotibial tracts of 10 young donors (mean age 31.2±9.1 years) were investigated biomechanically. After preconditioning, YM were determined in the ranges of 0-4 and 4-11 N/mm² of applied stress and from 4N/mm² of applied stress to US. RESULTS YM of the specimens were 84.7±30.2 (0-4 N/mm²), 335.4±101.9 (4-11 N/mm²), and 369.1±191.5 (4 N/mm² to US) N/mm², respectively. The mean US was 35.8±16.4 N/mm². YM and US correlated closely in the ranges of 4-11 N/mm² (r=0.95) and 4 N/mm² to US (r=0.91). YM did not correlate to age, body weight or gender within these young donors. Concerning tissue behavior a decrease of YM, i.e. weakening, is more common than an increase of YM, i.e. stiffening, before specimen failure. Overall, YM of specimens from young donors were significantly lower compared to those of old donors. DISCUSSION AND CONCLUSIONS This is the first study providing age-dependent nonlinear stiffness properties of the iliotibial tract. YM is significantly lower in young than in old donors and is thus a subject of alteration during life time.

Ethanol-glycerin fixation with thymol conservation: A potential alternative to formaldehyde and phenol embalming

Anatomical fixation and conservation are required to prevent specimens from undergoing autolysis and decomposition. While fixation is the primary arrest of the structures responsible for autolysis and decomposition, conservation preserves the state of fixation. Although commonly used, formaldehyde has been classified as carcinogenic to humans. For this reason, an adequate substitute was developed. Ethanol‐glycerin fixation and thymol conservation are described and compared with formaldehyde and phenol in this technical report. The setup, tissue qualities, financial aspects, and health concerns of this method are discussed. Ethanol‐glycerin fixation and thymol conservation provide outstanding haptic and optic tissue qualities. Typical formaldehyde and phenol effects, such as skin, airway, and eye irritation, as well as carcinogenic effects, can be circumvented by using ethanol‐glycerin and thymol instead. Ethanol‐glycerin fixation is more expensive than formaldehyde and requires an explosion‐proof facility. However, the absence of health effects and its convincing tissue qualities balance these higher costs. Therefore, ethanol‐glycerin fixation and thymol conservation provide a potential alternative and complement established fixation techniques. The use of carcinogenic formaldehyde and toxic phenol can be effectively restricted through the use of the described method. Anat Sci Educ.

Comparison of modified Thiel embalming and ethanol-glycerin fixation in an anatomy environment: Potentials and limitations of two complementary techniques.

Thiel‐fixed specimens have outstandingly lifelike visual and haptic properties. However, the original Thiel method is expensive and requires an elaborate setup. It is therefore of principal interest to modify the Thiel method in order to make it available to a broader user group. A modified Thiel embalming method will be described in detail and compared to ethanol‐glycerin fixation with the help of illustrative examples. The visual properties, haptic properties, the usability for performing histological investigations, costs and potential health aspects will be considered. Tissues fixed with the modified Thiel technique gave results similar to the original method, providing more realistic visual and haptic properties than ethanol‐glycerin embalming. However, Thiel fixation is significantly more expensive and requires more precautions to minimize potential health hazards than ethanol‐glycerin‐fixed tissues. In contrast to ethanol‐glycerin‐fixed specimens, the Thiel‐fixed specimens are not suitable for histological investigations. Both modes of fixation are inappropriate for biomechanical testing. Modified Thiel embalming simplifies the availability of body donors with lifelike properties and has cost‐saving advantages to the original technique. Thiel‐embalmed body donors are ideally suited for clinical workshops but have restrictions for student dissection courses in facilities with limited storage space, air circulation or technical staff. Vice versa, ethanol‐glycerin‐fixed body donors are well suited for student dissection courses in such an environment but are limited in their use for clinical workshops. Modified Thiel embalming therefore ideally complements ethanol‐glycerin fixation in order to provide customized solutions for clinical workshops and student dissection courses in a wide range of applications. Anat Sci Educ 8: 74–85.

Novel insights into the sacroiliac joint ligaments.

Study Design. The ligaments of the human sacroiliac joint (SIJ) were investigated morphometrically. Objective. A macroscopical study was performed to measure the anterior sacroiliac ligament (ASL), the interosseous sacroiliac ligament (ISL), and the posterior sacroiliac ligament (PSL), applying different methods of ligament visualization. Summary of Background Data. Little is known about the SIJ ligaments, especially about the ISL. Pelvic computer simulations neglect these ligaments due to the lack of information. Computer simulations of the SIJ ligaments may help to improve the clinical outcome of SIJ operations. Methods. Seven-Tesla MR images, CT images, and corresponding thin slice plastinates of the SIJ of 1 male and 1 female specimen were obtained. Serial sections of the SIJ of 32 frozen specimens (13 males, 19 females) were generated to gather measurements of the SIJ ligaments. Results. By means of the MR images and the plastinates, a virtual reconstruction of the SIJ ligaments was accomplished. Parallelepipeds were attributed to the cranial, middle, and caudal parts of all SIJ ligaments. This allowed precise measurements and statistical comparison including positional relationships. The ISL volumes and origin surfaces were the largest. Statistically, the ASL and PSL parameters were larger in males, while the ISL parameters were larger in females. The height of the cranial ASL part showed large negative correlations in spite of positive correlations of the other heights. Conclusion. The combined use of high-resolution MRI and thin slice plastination allows precise reconstructions of the SIJ ligaments. With these techniques, the ligaments can be visualized in situ and described morphometrically if based on substantive data. The SIJ ligaments are gender-dependent. This has to be taken into account for pelvic computer simulations.

Analysis of the posterior ramus of the lumbar spinal nerve: the structure of the posterior ramus of the spinal nerve.

Background:Knowledge of neural anatomy is fundamental for safe, efficacious use of regional anesthesia. Spinal column procedures, such as a facet joint block, require an accurate understanding of neural pathways relative to anatomic structure. Since Bogduk’s report it has been known that human lumbar posterior ramus of the spinal nerve (PRSN) comprises three, equally sized primary branches. However, inconsistencies and controversy remain over the exact locations and pathways of the peripheral portions of the PRSN branches. In this study, the authors investigated the detailed anatomy of the human PRSN. Methods:The authors performed ventral dissection in seven cadavers to determine the layout of the PRSN between T10 and L4 spinal segments. They captured three-dimensional images with a laser scanner. For fine detail analysis, specimens from another cadaver were subjected to a modified Spalteholz technique to render all nonnerve tissue transparent. Computer graphics were used to create a three-dimensional structural model. Results:All three PRSN branches emanated from an ipsilateral origin and passed posterior to the transverse process. The medial PRSN branch consistently passed between the mammillary and accessory processes under the mammilloaccessory ligament. The intermediate branch passed between the longissimus and iliocostalis muscles and extended to the skin. The lateral branch traveled far lateral from the origin. Conclusions:The authors created a 3D model of the PRSN in the lumbar segment, which may be useful for planning surgical approaches to dorsal areas of the vertebral column. In addition, this knowledge may improve the accuracy of procedures involving the spinal column, particularly radiofrequency neurolysis of the facet joint.

Combined multi-body and finite element investigation of the effect of the seat height on acetabular implant stability during the activity of getting up

An important question in assessing the stability of a total hip arthroplasty is the effect of daily physical activities of patients. The aim of this study is to examine these effects when standing up from three different seat heights. A musculoskeletal body model has been modified to simulate the three different seat heights. The calculated muscle forces have been transferred to a finite element model of a pelvis. The pelvis model was created from a hemipelvis CT dataset. As an implant component, a metal socket with a polyethylene insert was used. A primary implantation situation was modelled. For the analysed patient activities the highest hip contact forces and the highest micromotions occur at the beginning of the motion. The results of this study show that standing up from a certain seat height can have a significant influence on the micromotions in the implant-bone interface.

The sacrotuberous and the sacrospinous ligament--a virtual reconstruction.

Little is known about the morphometric properties of the sacrotuberous ligament (ST) and the sacrospinous ligament (SS). The influence of ligaments on pelvic stability and the extent of reconstruction in case of instability are controversially discussed. The ST and the SS of 55 human subjects fixed in alcohol solution and of four fresh cadavers were measured. Both ligaments were defined as geometric figures. The ST was a contorted bifrustum, while the SS was a contorted frustum, both with elliptic planes. In all cases investigated, the ST and the SS fibres were twisted. For men, the ST and the SS had a mean length of 64 and 38 mm. For women, lengths of 70 and 46 mm were measured in the ST and the SS. The ST length, height and cross-sectional area showed gender-specific differences at statistically significant level. The ST and the SS volumes correlated closely, regardless of gender or side. Measurements of fresh ligaments of four unfixed cadavers showed similar results. The data obtained were then used to generate computer-based three-dimensional models of both ligaments, using the Catia software. Conclusively, the virtually generated ST and SS are suitable models to be included in pelvic fracture simulation, using the finite element method.